By Yesenia Amaro, USC Center for Health Journalism News Collaborative
When Bob Stedman suffered a minor stroke in 2017, he got 60 individual checks from complete strangers, along with get-well cards and notes of encouragement.
The 55-year-old Orange County daddy of 5 used those checks, provided through a health care cost-sharing ministry, to pay for his $13,000 hospital expense. Countless Californians who struggle to manage personal insurance have actually turned to the faith-based, healthcare cost-sharing ministry model to pay for their medical care, but professionals warn that it is not a replacement for insurance, and one company associated with the field has actually faced allegations of tricking customers in other states, as well as complaints in California over billing disputes.
In Stedman’s case, quiting personal insurance for membership in the Samaritan Ministries program has actually conserved him cash while meeting his and his family’s medical needs. He acknowledges “no option is for everyone.”
Healthcare cost-sharing ministries offer the opportunity for individuals to pay into a system monthly and share healthcare costs amongst all members. For example, an individual’s month-to-month payment is used to pay the medical costs for a member in requirement. Once a member’s annual dedication has actually been fulfilled, and a medical requirement arises, the month-to-month payments from other members are used to offset that person’s costs.
The types of services covered are limited, and typically do not consist of main and preventive care. And for services that are covered, there are typically restricts to how much the ministry will pay towards particular costs (for Samaritan Ministries, the maximum for its standard plan is $250,000 per healthcare episode).
“Do individuals take danger? Of course,” Nadereh Pourat, a professor-in-residence at the UCLA Fielding School of Public Health, said of cost-sharing ministries. She also directs the Health Economics and Evaluation Research Program at the UCLA Center for Health Policy Research. “The danger is that this is not an insurance policy.”
Such ministries also are based upon biblical and spiritual principles, which can even more restrict coverage.
About 1.4 million individuals across the country are enrolled in signed up faith-based healthcare cost-sharing programs, according to the Alliance of Health Care Sharing Ministries, consisting of at least 75,000 members in California. Samaritan Ministries had 3,968 member families in California as of October, representing 12,488 people, according to an email statement on behalf of Samaritan Ministries sent by Patrick Benner of Hamilton Methods, a public relations firm.
Samaritan individuals are asked to pay a “month-to-month share” based upon their membership level to cover the healthcare costs of a member in requirement, as well as to wish that person. When a medical requirement arises, a member can send itemized costs and demand payment from other members’ shares.
Stedman said his family pays about $550 a month for six family members, including his other half and four of their 5 children.
The Stedmans, who are practicing Christians, had health coverage through Blue Cross before 2012 when they changed to Samaritan Ministries. The family had actually seen its Blue Cross premiums skyrocket over the past years, Stedman said.
The family was paying about $1,500 a month for health insurance for the 5 children and the moms and dads. They were able to cut their costs significantly when they changed to a sharing ministry.
“We could theoretically put the additional money in our checking account,” he said.
Starting this month, California implemented an individual mandate that needs individuals to have minimum healthcare coverage or deal with a tax charge. The charge will be administered by the state’s Franchise Tax Board, according to James Scullary, a representative for Covered California.
“A person enrolled in a health care-sharing ministry plan can declare an exemption to the charge when they submit their taxes,” he said.
To be exempt from California’s private mandate, healthcare cost-sharing ministries must have been in presence at all times because Dec. 31,1999, with medical costs for their members shared without interruption.
Samaritan began sharing medical costs for its members in 1994, according to its site.
The California Franchise Tax Board, which will administer the private mandate, said it didn’t have a list of healthcare cost-sharing ministries that would or would not be exempt from the private mandate, and it suggested individuals contact their respective ministries.
The state’s Department of Insurance coverage doesn’t manage healthcare cost-sharing ministries, and neither does any other state department.
“Given that they don’t offer insurance, they aren’t accredited by the state,” a department spokesperson said.
Distinctions between health ministries and health insurance
Samaritan is among nine such ministries running in California that are signed up with the Centers for Medicare and Medicaid. Two of them are churches that restrict their service to church members just, the alliance spokesperson said.
No federal agency spokesperson responded to the Center for Health Journalism Collaborative’s questions about cost-sharing ministries, consisting of the Centers for Medicare and Medicaid.
“I‘m afraid I’m just not in a position to address your question about who controls the ministries,” said Jack Cheevers, a CMS spokesperson who at first referred a reporter’s questions to the U.S. Treasury Department.
The U.S. Treasury Department did not return questions seeking comment.
Healthcare cost-sharing ministries just cover specific services. Cancer is covered, but there could be constraints in coverage if the person was identified with cancer before ending up being a member.
Medical care, long-term care, contraceptives and abortion are amongst a list of medical needs not covered for Samaritan members.
Medical needs must also not arise from “conduct inconsistent with membership requirements.”
Members are required to restrict their alcohol consumption, and avoid sex “outside the biblical marital relationship,” for example. As an outcome, treatment for sexually transmitted diseases, such as HIV and AIDS, is not covered if the disease was contracted by consensual sex outside of marital relationship or through irresponsible habits, according to Samaritan’s standards.
In Stedman’s case, his stroke was caused by hypertension. His stroke costs were covered by his membership in the health care ministry, his ongoing medication to handle high blood pressure is not due to the fact that main and preventive care are not consisted of in the faith-based model. He has to pay $30 monthly for his medication, which he doesn’t mind, given the cost savings.
He just paid $300 in hospital costs, and the hospital lowered the rest of his initial $51,000 expense to $13,000 due to the fact that he said he got a discount for paying in cash and lacking health insurance. That last expense was shared amongst Samaritan Ministries’ members.
Stedman, who hasn’t had any problems with Samaritan Ministries, said his family doesn’t mind going without main and preventive coverage.
“We don’t go to the doctor for every sniffle that we have,” he said.
A comprehensive health insurance policy pays for main and preventive care, as well as prescriptions, treatment, specialty care and emergency clinic check outs.
Some ministries market their programs with language that might lead some to believe they are buying a health insurance policy, Pourat said. Unless an individual actually comprehends the ins and outs of health insurance, they might not know the difference.
A medical insurance policy has to comply with the Affordable Care Act by providing what’s known as “minimum necessary coverage.” Programs that offer limited services or just discounts do not certify.
“The entire principle of insurance is when something fails, and when you need a particular type of service, you can get it,” Pourat said.
“If you have a chronic health condition, perhaps Samaritan is not for you,” Stedman said.
Benner, of Samaritan Ministries, said individuals with health insurance can also participate in a health care cost-sharing program. For guaranteed members, their medical needs are first submitted to their healthcare policy, and if there are staying costs that are qualified to be shared, they will get covered by the ministry.
Members also have the capability to select a more pricey plan to receive a higher repayment for injuries or diseases, he said.
The level of payment can depend on the number of relative, the number of total members within the ministry and what their medical needs are.
Issues with Aliera in California
One company that works in the healthcare cost-sharing ministry field, Aliera Health care Inc., has actually come under scrutiny in several states for supposedly deceptive customers about its services. It is also under examination in California, where two complaints over billing disputes against the company were lodged in the past 5 years.
In July, Texas took legal action against Aliera to try to stop the company from continuing to offer its product, stating it was marketing “excellent healthcare with detailed medical strategies.” The match alleges Aliera was selling insurance without a necessary state license.
According to some complaints against Aliera submitted with the Bbb, individuals state they paid thousands of dollars on month-to-month member contributions, and thousands of dollars more when a medical concern arose, and Aliera would not cover the costs.
Authorities in California, however, acknowledged there are no laws to manage entities such as Aliera and Samaritan in the state. It would depend on the state Legislature to change that.
The California Department of Managed Care denied a public records ask for copies of the two complaints against Aliera submitted in California. The department said they are exempt from the California Public Records Act, based upon protected details that would violate a person’s right to privacy.
The agency would not launch redacted copies, either.
Aliera said in a declaration that it does administrative and marketing work on behalf of healthcare cost-sharing ministries, such as Trinity HealthShare in California, and is not accountable for concerns connected to the services offered by the ministries.
Trinity HealthShare has 7,630 members in California, and continues to take new clients, a representative for Aliera said in a declaration.
Aliera rejects the accusations in state claims and investigations, and said it will “intensely defend” its position.
“We stay committed to serving health care-sharing members in California and somewhere else, dealing with regulators to provide the health care-sharing services these members need,” its statement checks out.
While some states need written disclaimers defining that a health care cost-sharing ministry is not an insurance provider, California does not, a 2018 report from The Commonwealth Fund discovered. California also doesn’t need month-to-month disclosures and annual audits for these entities.
Trinity HealthShare specifies on its site that its programs are not insurance, and Samaritan Ministries on its site describes healthcare sharing as “a way that Christians are paying for their healthcare without utilizing health insurance.”
For now, Stedman has no regrets about turning to Samaritan Ministries and its healthcare cost-sharing model for his and his family’s healthcare. “They have a 25-year track record,” he said.
The Uncovered California job results from an ingenious reporting endeavor– the USC Center for Health Journalism News Collaborative– which includes print and broadcast outlets throughout California, all reporting together on the state’s uninsured. Outlets consist of newspapers from the McClatchy Corp., Gannett Co., Southern California News Group, and La Viewpoint, as well as broadcasters at Univision and Capital Public Radio.Source: ocregister.com